Nhs students and lack of consent.

A large part of this depends on how it is done. And that depends on the interpersonal skills of the medical professional and the students themselves.

If there were multiple students just staring at me in silence with clipboards and I was made to feel like a medical spectacle, I would feel uncomfortable even if I had given consent in advance. One of my friends had a vaginal twin birth and, having agreed to one student, she had to put her foot down when a group trouped in. She said they were just staring at her and standing around her awkwardly while she was in pain. It stressed her out and she was worried it was going to slow things down.

On the other hand, I didn't feel uncomfortable having a student at my midwife appointments or having a dental student, because there was only one student who felt like part of the team and had a role to play fetching stuff and generally being useful. And I was normally asked if they called the student over to look at something rather than being ignored as they talked over me.

Personally, I wouldn't feel awkward in most situations (including internal examinations) with one student there as they're just 'the student'. I would like to be asked though. But with more than one I would feel awkward - if there's a group of students, patients can be treated more like a teaching experience than a person and that's not right!

If you are thinking of applying to a healthcare course/training scheme you can ask to visit and as part of that you can get to sit in on a consultation.

The patient might be under the impression that the student was a student doctor or nurse but it could be someone off the street.Not so bad if it’s audiology but about à gynaecological examination?

@PrivateHall

How to say “I don’t believe you” without saying “I don’t believe you”.

I have always been asked if it's ok to have a student present and, having been a student, I have no problem with them. I can see how it would be difficult for some people though.

It's also highly unlikely that a student delivering her first baby would be asked to break your waters.

I think it’s good you stuck up for yourself. It’s nice I guess to help the students but it’s your body at the end of the day so YANBU.

I've always been asked, most of the time the medical students introduce themselves.

On my last op there was a student shadowing the anesthetist, I asked the student if she wanted to intubate and the anesthetist was very clear to the student that anything else would be assault.

I think it's better for a student to learn to intubate with an anesthetist at their side and not in an emergency,

This is a horrific invasion of privacy. The odd time I've been attended by a medic with a student its only ever one. It's always been explained to me who they are, it has never felt intrusive and I wouldn't have dreamt of objecting. I wonder if it makes a difference that the doctor or midwife in charge was a woman, I am suspecting yes.

It does sound like you've been unlucky. Sorry to hear.

I've always been asked if students can be there. I say yes to female and no to male.

If seeking consent properly isn't deemed a priority, what else is ignored or disrespected in terms of patient care?

There was a study a few weeks back stating that female patients get poorer outcomes if they have a male surgeon. The same wasn't true if they were a male patient or they had a female surgeon.

Something is going on here at a cultural level. Listening to a patient better means quicker diagnosis, better patient doctor relationships and better outcomes. We know this. So when it's demonstrated that the patient's input on consent is a nuisance or inconvenience or something that should be coerced in some way, its demonstrating a poor wider culture.

Tbh, I'd be more inclined to consent if it was done in a reasonable fashion, rather than put on the spot in front of the student.

What you are saying by having the student present when asking is that the student is more important than the patient and that its conveyer belt medicine where you cease to be an individual. You are just another case.

And you are teaching this culture to the next generation.

No its not ok. On so many levels and its worrying that so many people don't understand nor value the fact that the circumstances and the way you are asked for consent matter.

For me, its damaging to trust before you even start if aren't fully aware that the how matters.

This sounds like seriously bad luck, as you can see no other posters seem to have had the same experience. It sounds quite specific to your trust.

The breaking the waters thing is really weird. I have never heard of a student midwife learn to break waters before assisting the birth of a baby (you say it was the first birth she had assisted with), that is really peculiar. I do wonder if you were misled there in some way. Student midwives would experience their first birth within their first week in an intrapartum placement but usually wouldn't break waters until a couple of years later - if at all. Many of us don't do it until we are qualified.

It also is highly unusual to break your waters 'without any discussion', for one it involves you adopting a certain position - not sure how this could be achieved without discussion. It tents to take some time and is really quite tricky to do for induction, so this whole thing sounds rather odd. I do wonder if the midwife did it and was talking the student through what she was doing.

I'm a student with the nhs and I am so sorry this has been your experience. It really isn't on that you aren't being asked. With my training the first thing we were taught in year 1 was to seek consent ourselves to be present/ carry out an exam etc. I always make sure that the client knows who I am/ why I am there and clearly seek their consent for me to remain in the room. Even if my supervisor has gained their consent I also ask if it is okay as I don't want to do anything without consent.

Honestly, you experiences are not okay and if it happens again I would be wanting to take it further. Would be tempted to raise these issues now as well.

How people are asked matters because one way makes it harder to say no, than another.

Saying you are going to do something and then asking for permission is flawed.

It creates a power dynamic that some people - particularly vulnerable people - find hard to challenge.

Its intimidating to be 1 person versus say 3. Even without the status of doctor and the idea that you might fear you will be refused treatment if you don't consent.

Anyone who isn't aware of this, really doesn't understand the fundamental principles of consent and undue pressure.

Thats the really troubling thing.

There are always patients for whom it is inappropriate for students to be even considered or for whom its particularly relevant to do as much as possible to ensure consent isn't under duress.

Consent relies on the principle that you should be able to say no without the no then being questioned or challenged or judged in anyway.

Do you not know what the word "personally" means? then followed with "...consent should always be asked too"

You also said “how else do they learn?”. That’s a question, not a personal statement, presumably directed to people who aren’t comfortable with having observers sitting in on their appointments.

I've always been asked for consent but I think the difference is they are present now. For example my hospital had notices up about being a teaching hospital and students being present but when I had an appointment with my consultant a junior doctor was already sat in the room and I was asked if he could stay. I consented but it does put pressure on people who might be less confident. Same with a midwife checkup the trainee midwife was aready in the room when I was asked if she would be allowed to be present and involved in the check up.

I have been in a similar situation re a smear. I find the process difficult (documented in notes) and was told I could not have my dh with me due to covid but having two students in the room was OK?

When I was a student we had to wait outside until the patient had been asked and then only enter if allowed. The patient was not put under any undue pressure then.

Ds is a magnet for students (I think because he is an unusual complex case) and we have always been asked if it’s ok for students to be present so it’s never been an issue.

A fantastic opthamology student noticed something the consultant had missed which has been key in his ongoing treatment

Doubtless you also moan about lack of GP appointments and long NHS waiting lists too.

Wtf are you talking about?

I went to my optician for a routine check up and there was a trainee Dr from our local hospital already in the testing room. I had to ask who the guy in the corner was as no one mentioned it. The person didn't speak to me about my eyes but only to the optician. I could have been a dog.

It wasn't even a NHS appointment, but one I was paying privately for.

Afterwards, I wrote a complaint letter explaining that I thought it was a cheek not to even ask me when it was purely a private appointment, and that the Dr did not speak to me.

I go to a different optician now.

When I asked who they were I was told they were trainee health care assistants. I objected and the nurse insinuated I was being a bit silly and shy. I left that appointment without it being done.

Thats sufficient grounds for a formal complaint because you were placed under undue pressure and your 'no' was not accepted.

Did you raise a formal complaint?

Unless you do, then these hcps will just do it repeatedly.

If you raise a complaint and ask for it to be put on your file they you are unhappy about being used for training, then it adds weight to every subsequent time it happens again.

Its inexcusable.

Yes doctor have to be trained. But some patients are not appropriate subjects and consent must be properly sort and given.

No exceptions. Ever.

On the odd occasion I have had to see my GP and a student might be there I was always asked for consent by the receptionist first when I arrived and checked in, before I even saw the doctor.

I used to get students occasionally when I was a kid - thinking about it, I was asked if I was OK with the student being there, but only after I'd entered the room and sat down and the student was already there. I was Gillick competent at the time, and I was OK with the student as it wasn't anything particularly embarrassing, but given how difficult grown women find it to be assertive in these situations, did they really expect a young girl to be able to say no in front of the student?

I think consent should be asked, ideally in advance, so patients have time to reflect on whether they are OK with it, rather than feeling pressured to say yes. And that consent should be asked again on the day, and that it can be removed if the patient decides for any reason they don't feel comfortable anymore.

Sometimes you're mentally resilient enough to think, 'It's fine, everyone needs to learn.' Sometimes you're so miserable and vulnerable that you can barely tolerate the lead physician being in your personal space. You'd have thought that a medical expert wouldn't need that pointed out...

Doubtless you also moan about lack of GP appointments and long NHS waiting lists too.

Literally none of these would bother me.

But I get where you're coming from on the consent side of things.